Menu

8. Foot and Ankle MCQs

Practice Set 61 of 353

This practice set contains high-yield board review questions covering key concepts in 8. Foot and Ankle. Each clinical scenario is designed to test your diagnostic and management skills relevant to this subspecialty.

Question 1201

Topic: 8. Foot and Ankle

A 12-year-old patient presents with severe congenital fibular hemimelia, resulting in a significant limb length discrepancy of 6.5 cm, ankle valgus, and a foot deformity, as seen in the clinical image below. The patient exhibits a highly inefficient gait with pronounced circumduction and vaulting, and experiences chronic fatigue.

Based on the comprehensive understanding of gait, LLD management, and Paley principles presented in the case, the most appropriate surgical approach for this patient would involve:

. A single-stage lengthening of the tibia to address only the LLD, followed by observation of the foot and ankle.
. Amputation of the affected limb to improve prosthetic fitting and gait efficiency.
. A complex, multi-level reconstruction addressing LLD, angular deformities, and foot/ankle alignment.
. Prescription of a custom orthosis and shoe lift as the definitive long-term management.
. Isolated correction of the ankle valgus deformity, as it is the most visually apparent issue.

Correct Answer & Explanation

. A complex, multi-level reconstruction addressing LLD, angular deformities, and foot/ankle alignment.

Explanation

Correct Answer: CThe patient presents with a 'Severe (> 5.0 cm)' LLD (6.5 cm), which the case states 'often associated with congenital deformities (e.g., Fibular Hemimelia)' and requires 'Complex surgical reconstruction. May require multi-level lengthening, external fixation (Taylor Spatial Frame), or combined lengthening and deformity correction.' The clinical image and description also indicate associated ankle valgus and foot deformity. Therefore, a complex, multi-level reconstruction addressing LLD, angular deformities, and foot/ankle alignment (Option C) is the most appropriate and comprehensive approach, aligning with the principles of restoring overall dynamic biomechanical function. Option A is insufficient as it only addresses LLD and ignores the associated deformities. Option B (amputation) is a drastic measure and not the primary recommended approach for fibular hemimelia in the context of limb salvage and reconstruction. Option D (orthosis and shoe lift) is inadequate for a severe LLD with complex deformities. Option E (isolated ankle valgus correction) would not address the significant LLD or other potential deformities, leading to continued gait pathology.

Question 1202

Topic: 8. Foot and Ankle

A 38-year-old male presents with chronic knee pain and difficulty with ambulation, noting his knee 'gives way' backward during stance. A full-length lateral standing radiograph is obtained. According to Paley's principles, the Sagittal Mechanical Axis is a conceptual plumb line dropped vertically from the center of the femoral head. In a normally aligned lower extremity, where should this plumb line ideally pass?

. Directly through the center of the knee joint and posterior to the ankle joint.
. Posterior to the center of the knee joint and directly through the center of the ankle joint.
. Slightly anterior to the center of the knee joint and directly through the center of the tibiotalar (ankle) joint.
. Directly through the center of the knee joint and anterior to the ankle joint.
. Slightly posterior to the center of the knee joint and anterior to the tibiotalar (ankle) joint.

Correct Answer & Explanation

. Slightly anterior to the center of the knee joint and directly through the center of the tibiotalar (ankle) joint.

Explanation

Correct Answer: CThe text explicitly states, 'In a normally aligned lower extremity, this mechanical plumb line passes slightly anterior to the center of the knee joint and directly through the center of the tibiotalar (ankle) joint.' This specific alignment is crucial for efficient knee locking during the stance phase of gait with minimal muscular energy expenditure. Any deviation from this alignment constitutes a Sagittal Mechanical Axis Deviation (MAD), indicating a sagittal plane deformity.Option A is incorrect because the plumb line should not pass directly through the knee, nor posterior to the ankle.Option B is incorrect as passing posterior to the knee would indicate a significant recurvatum tendency, requiring constant quadriceps activity to prevent collapse.Option D is incorrect because passing directly through the knee and anterior to the ankle is not the normal alignment described.Option E is incorrect as this describes an abnormal alignment that would lead to significant gait instability and increased energy expenditure.

Question 1203

Topic: 8. Foot and Ankle

A 60-year-old patient with a long-standing history of post-traumatic knee deformity presents with genu recurvatum. Despite the significant bony deformity, the patient's gait appears surprisingly stable and functional, albeit with some compensatory mechanisms. The image below illustrates the biomechanics of this compensation. Which of the following statements accurately describes the primary compensatory mechanism employed by the body to maintain a plantigrade foot and functional gait in a patient with osseous knee recurvatum, assuming normal muscle strength?

. Increased hip flexion during the stance phase to shift the center of gravity anteriorly.
. Active quadriceps contraction throughout the stance phase to prevent hyperextension.
. Compensatory plantar flexion at the ankle joint to allow the foot to reach the ground.
. Increased knee flexion during the swing phase to clear the ground.
. Pelvic obliquity and trunk lean to balance the sagittal plane deformity.

Correct Answer & Explanation

. Compensatory plantar flexion at the ankle joint to allow the foot to reach the ground.

Explanation

Correct Answer: CThe text explicitly states, 'To maintain a level pelvis, a forward gaze, and a functional stride length, the body must compensate for the altered bone shape. In the case of osseous knee recurvatum, this compensation occurs almost entirely at the ankle joint. To get the foot flat on the ground (plantigrade) when the tibia is angled backward, the ankle must go into compensatory plantar flexion.' The provided diagram (ch_290_fig_26a282.webp) visually confirms this, showing the knee recurvatum balanced by 15° compensatory plantar flexion at the ankle.Option A is incorrect. While hip flexion can be a compensatory mechanism for other deformities, the primary compensation for osseous knee recurvatum to achieve a plantigrade foot is at the ankle.Option B is incorrect. While active muscle control is used to prevent the knee from snapping into full passive hyperextension, the primarycompensatory mechanismfor the bony deformity to achieve foot-flat is at the ankle, not continuous quadriceps contraction which would be highly energy-inefficient.Option D is incorrect. Increased knee flexion during swing phase is a common compensation for limb length discrepancy or foot drop, not the primary mechanism for osseous recurvatum to achieve a plantigrade foot.Option E is incorrect. Pelvic obliquity and trunk lean are more commonly associated with coronal plane deformities or leg length discrepancies, not the primary sagittal plane compensation for osseous knee recurvatum.

Question 1204

Topic: 8. Foot and Ankle

A 32-year-old patient, an avid runner, presents with chronic anterior knee pain and a feeling of instability during push-off. Radiographic analysis reveals an ADTA (Anterior Distal Tibial Angle) of 75°. Based on Paley's principles, what is the most appropriate interpretation of this finding and its potential clinical significance?

. The patient has a normal distal tibial alignment, and the pain is likely due to patellofemoral syndrome.
. The patient has a distal tibial recurvatum (hyperextension) deformity, which could lead to increased ankle dorsiflexion.
. The patient has a distal tibial procurvatum (flexion) deformity, which could lead to compensatory ankle plantarflexion.
. The patient has a proximal tibial recurvatum deformity, requiring a proximal tibial osteotomy.
. The patient has a significant sagittal plane joint line convergence angle, indicating an intra-articular problem.

Correct Answer & Explanation

. The patient has a distal tibial procurvatum (flexion) deformity, which could lead to compensatory ankle plantarflexion.

Explanation

Correct Answer: CThe table in the text defines the ADTA (Anterior Distal Tibial Angle) with a normal value range of 78° to 82° (Mean 80°). It explicitly states, 'An ADTA < 78° indicates a procurvatum (flexion) deformity of the distal tibia.' An ADTA of 75° is less than 78°, confirming a distal tibial procurvatum (flexion) deformity. A procurvatum deformity of the distal tibia would cause the foot to be more dorsiflexed relative to the tibia, and to achieve a plantigrade foot, the ankle would need to compensate with plantarflexion.Option A is incorrect as 75° is outside the normal range for ADTA.Option B is incorrect; a recurvatum deformity would be associated with a larger ADTA, not a smaller one. Also, recurvatum would lead to compensatory plantarflexion, not increased dorsiflexion.Option D is incorrect; the ADTA assesses the distal tibia, not the proximal tibia. Proximal tibial recurvatum is assessed by the PPTA.Option E is incorrect; the JLCA assesses joint convergence, and the ADTA measures bony alignment. There is no information about the JLCA here, and a bony deformity is clearly indicated by the ADTA.

Question 1205

Topic: 8. Foot and Ankle

A 12-year-old patient with spastic diplegic cerebral palsy presents with a severe bilateral knee flexion deformity of 40 degrees. Clinical examination reveals that the patient is an obligate toe-walker, and despite maximal effort, cannot achieve a plantigrade foot position. Which of the following statements best explains this patient's gait pattern?

. The ankle joint is compensating with excessive plantarflexion to maintain balance.
. The GRV is passing anterior to the knee, creating an extension moment that is overwhelmed.
. The body's ability to compensate distally through ankle dorsiflexion has been physiologically overwhelmed.
. The primary compensation is increased hip extension to shift the center of mass posteriorly.
. The functional leg length discrepancy is primarily due to contralateral limb shortening.

Correct Answer & Explanation

. The body's ability to compensate distally through ankle dorsiflexion has been physiologically overwhelmed.

Explanation

Correct Answer: CThe case describes that when the FFD exceeds 20-25°, the body's ability to compensate distally (through ankle dorsiflexion) reaches its absolute physiological limit. The ankle simply cannot dorsiflex enough to maintain a plantigrade foot while accommodating the severe knee bend. This leads to an obligate toe-walking or equinus gait, as the heel is forced to lift off the ground. The image provided perfectly illustrates this, showing that with a 40° knee FFD, even maximal ankle dorsiflexion (20°) is insufficient, forcing the heel off the ground.Option A is incorrect. The ankle is attempting to dorsiflex to compensate for the knee flexion. Obligate toe-walking occurs because the ankle's dorsiflexion capacity is exhausted, not because it is actively plantarflexing. The heel lifts because the foot cannot reach the ground in a plantigrade position.Option B is incorrect. In any FFD, the GRV passes posterior to the knee, creating a flexion moment. It does not pass anteriorly.Option D is incorrect. The primary proximal compensation for FFD is increased hipflexionand an anterior trunk lean, not hip extension.Option E is incorrect. While a functional leg length discrepancy does occur in severe FFD, it is due to the flexed posture functionally shortening the affected limb's vertical height, causing the pelvis to drop on the affected side. It is not primarily due to contralateral limb shortening.

Question 1206

Topic: 8. Foot and Ankle

A 55-year-old patient presents with a 20-degree fixed knee flexion deformity. Radiographs show a normal Posterior Distal Femoral Angle (PDFA) of 83° and a normal Posterior Proximal Tibial Angle (PPTA) of 81°. However, the patient has a rigid ankle equinus deformity, limiting ankle dorsiflexion to 0 degrees. During gait, which of the following compensatory mechanisms will be most pronounced?

. Increased ankle dorsiflexion to maintain a plantigrade foot.
. Obligate toe-walking due to overwhelmed distal compensation.
. Exaggerated hip flexion and anterior trunk lean.
. Increased quadriceps activity to generate an extension moment.
. Posterior shift of the sagittal mechanical axis deviation.

Correct Answer & Explanation

. Exaggerated hip flexion and anterior trunk lean.

Explanation

Correct Answer: CThe case emphasizes that a mobile, supple ankle is the single most important factor in the body's ability to compensate for a knee flexion deformity. If the ankle is stiff and cannot dorsiflex, this primary distal compensatory mechanism is entirely lost. The diagram provided (ch_289_fig_c4651e.webp) perfectly illustrates this: when a knee FFD is combined with a stiff ankle that cannot dorsiflex, the patient has no choice but to shift all compensation proximally, adopting an exaggerated hip flexion posture with a severe anterior lean of the trunk. This allows them to place the foot flat on the ground, but at a tremendous biomechanical cost.Option A is incorrectbecause the patient has a rigid ankle equinus deformity, meaning increased ankle dorsiflexion is impossible.Option B is incorrect. While obligate toe-walking can occur with severe FFD, in this specific scenario, the text and image indicate that with a stiff ankle, the body prioritizes getting the foot flat by shifting compensation proximally (hip flexion/trunk lean), rather than necessarily toe-walking, which would be even more unstable with a stiff ankle.Option D is incorrect. Increased quadriceps activity is a direct consequence of the posterior GRV in FFD, not a compensatory mechanism to generate an extension moment. The quadriceps are working to prevent collapse, not to actively extend the knee beyond the FFD.Option E is incorrect. A knee flexion deformity causes ananteriorshift of the sagittal mechanical axis deviation, not a posterior shift.

Question 1207

Topic: 8. Foot and Ankle

A 70-year-old female presents with a progressive knee flexion deformity and a history of chronic quadriceps fatigue. Full-length lateral radiographs are obtained. To accurately quantify the sagittal mechanical axis deviation (MAD) according to Paley's principles, which of the following landmarks should be used to initiate the plumb line?

. The center of the patella
. The anterior aspect of the tibial tubercle
. The center of the femoral head
. The posterior aspect of the calcaneus
. The most anterior point of the knee joint

Correct Answer & Explanation

. The center of the femoral head

Explanation

Correct Answer: CThe case explicitly states that the sagittal mechanical axis is represented by the body's weight-bearing line. Clinically and radiographically, this can be visualized by dropping a plumb line from thecenter of the femoral head(or the center of the C7/T10 vertebral body for global balance) on a full-length lateral radiograph. This plumb line then ideally passes through the anterior half of the knee joint and directly through the center of the ankle joint in a normally aligned limb.Options A, B, D, and E are incorrectas they represent local anatomical landmarks that are not used as the origin for defining the global sagittal mechanical axis deviation of the lower limb. The center of the femoral head is the proximal anchor for the mechanical axis of the lower extremity.

Question 1208

Topic: 8. Foot and Ankle

A 40-year-old patient with a 10-degree fixed knee flexion deformity demonstrates a gait pattern characterized by increased hip flexion and an anterior lean of the trunk during mid-stance. The ankle joint shows increased dorsiflexion to maintain a plantigrade foot. This compensatory strategy is most indicative of which severity of knee flexion deformity?

. Severe FFD (>20-25 degrees) with obligate toe-walking.
. FFD combined with a rigid ankle equinus deformity.
. Mild FFD (5-15 degrees) with intact distal and proximal compensatory mechanisms.
. FFD with a posterior sagittal mechanical axis deviation.
. FFD requiring immediate surgical intervention due to complete loss of compensation.

Correct Answer & Explanation

. Mild FFD (5-15 degrees) with intact distal and proximal compensatory mechanisms.

Explanation

Correct Answer: CThe case describes that with a mild FFD (5-15°), the initial gait alterations involve two primary compensations: 1) Proximal compensation: increased hip flexion and a slight anterior lean of the trunk to shift the body's center of mass forward, and 2) Distal compensation: the ankle moves into increased dorsiflexion to keep the foot plantigrade. The image provided (ch_289_fig_7c6a00.webp) perfectly illustrates this mild FFD compensation, showing the knee in flexion, the ankle in dorsiflexion, and the GRV posterior to the knee.Option A is incorrect. Severe FFD (>20-25 degrees) typically overwhelms ankle dorsiflexion, leading to obligate toe-walking, which is not described here as the primary compensation.Option B is incorrect. If the FFD were combined with a rigid ankle equinus, the ankle would not be able to dorsiflex, forcing even more pronounced proximal compensation (hip flexion/trunk lean) to achieve a plantigrade foot, as shown in ch_289_fig_c4651e.webp. The description here includes ankle dorsiflexion, indicating a mobile ankle.Option D is incorrect. A knee flexion deformity causes ananteriorsagittal mechanical axis deviation, not a posterior one.Option E is incorrect. While FFD often requires intervention, the described compensatory mechanisms indicate that the body is still managing to some extent, characteristic of a mild deformity, not a complete loss of compensation.

Question 1209

Topic: 8. Foot and Ankle

At initial contact (heel strike) during a normal gait cycle, the ground reaction force (GRF) vector typically passes posterior to the center of rotation of the ankle joint. What external moment does this create at the ankle?

. Plantarflexion moment
. Dorsiflexion moment
. Inversion moment
. Eversion moment
. Internal rotation moment

Correct Answer & Explanation

. Plantarflexion moment

Explanation

Because the GRF passes posterior to the ankle joint at initial contact, it creates an external plantarflexion moment. The ankle dorsiflexors (primarily the tibialis anterior) must contract eccentrically to prevent foot slap.

Question 1210

Topic: 8. Foot and Ankle

A 14-year-old patient presents with a procurvatum deformity of the proximal tibia due to premature closure of the anterior tibial physis. During the stance phase of gait, what compensatory mechanism is the patient most likely to employ to keep the foot flat and balance the center of gravity?

. Genu recurvatum of the contralateral knee
. Increased ankle plantarflexion (equinus)
. Increased hip extension
. Lumbar kyphosis
. A flexed knee posture

Correct Answer & Explanation

. A flexed knee posture

Explanation

A procurvatum deformity (apex anterior) shifts the mechanical axis anteriorly. To compensate and bring the center of gravity back over the foot, the patient typically adopts a flexed knee posture during stance.

Question 1211

Topic: 8. Foot and Ankle

A patient undergoing clinical gait analysis exhibits circumduction of the swing leg, an unyielding stiff knee during swing, and a notable foot drop. This 'hemiplegic' gait pattern is a classic manifestation of a lesion in which location?

. Basal ganglia
. Cerebellum
. Upper motor neurons (Cortical/subcortical)
. Lower motor neurons (Peripheral nerve)
. Dorsal columns

Correct Answer & Explanation

. Upper motor neurons (Cortical/subcortical)

Explanation

A hemiplegic gait, characterized by an extensor synergy pattern, stiff knee, foot drop, and circumduction for clearance, is the hallmark of an upper motor neuron lesion, such as that caused by a cerebrovascular accident (stroke).

Question 1212

Topic: 8. Foot and Ankle

A 6-year-old boy with spastic diplegic cerebral palsy presents with a "crouch gait." Kinematic gait analysis shows excessive knee flexion during the stance phase. Which of the following surgical interventions from his prior history most likely contributed to the development of this specific gait pattern?

. Distal hamstring lengthening
. Isolated psoas recession
. Bilateral adductor tenotomies
. Isolated Achilles tendon lengthening
. Femoral derotation osteotomies

Correct Answer & Explanation

. Isolated Achilles tendon lengthening

Explanation

An isolated lengthening of the Achilles tendon in a patient with coexisting hamstring or hip flexor contractures frequently results in a loss of the plantarflexion/knee-extension couple. This removes resistance to tibial advancement, driving the knee into excessive flexion and creating a crouch gait.

Question 1213

Topic: 8. Foot and Ankle
A 48-year-old male sustains a calcaneal fracture after a motor vehicle collision. Initial lateral radiographs of the foot reveal a Böhler's angle of 10 degrees and a Gissane's angle of 160 degrees. Based on these findings and the provided case information, what do these angular measurements primarily indicate?
. Restoration of calcaneal height and subtalar joint congruity.
. Normal calcaneal morphology and stable posterior facet.
. Significant loss of calcaneal height and depression of the posterior facet.
. Isolated anterior process fracture without articular involvement.
. Medial wall blowout fracture with tarsal tunnel impingement.

Correct Answer & Explanation

. Significant loss of calcaneal height and depression of the posterior facet.

Explanation

Böhler's angle (tuber joint angle) normally ranges from 20-40 degrees, and a decrease signifies loss of calcaneal height and subtalar joint depression. The critical angle of Gissane normally ranges from 120-145 degrees, and an increase indicates depression of the lateral portion of the posterior facet. In this patient, a Böhler's angle of 10 degrees directly indicates a significant loss of calcaneal height and subtalar joint depression. A Gissane's angle of 160 degrees also suggests a disruption and likely depression of the posterior facet.

Question 1214

Topic: 8. Foot and Ankle

A 55-year-old male is undergoing open reduction internal fixation (ORIF) of a displaced intra-articular calcaneal fracture via an extensile lateral approach. During the approach, the surgeon must be particularly vigilant to protect which neurovascular structure that courses along the lateral aspect of the hindfoot and is highly vulnerable?

. A. Posterior tibial nerve
. B. Deep peroneal nerve
. C. Sural nerve
. D. Superficial peroneal nerve
. E. Medial plantar nerve

Correct Answer & Explanation

. C. Sural nerve

Explanation

Correct Answer: CExplanation:The case explicitly states under 'Surgical Anatomy & Biomechanics' that 'The sural nerve courses along the lateral aspect of the hindfoot and is particularly vulnerable during lateral surgical approaches.' Furthermore, under the 'Extensile Lateral Approach (ELA)' section, it emphasizes that 'Protection of the sural nerve, which lies subcutaneously, is paramount' during full-thickness flap elevation.A. Posterior tibial nerve:This nerve is part of the tarsal tunnel contents and lies on the medial aspect of the ankle, not the lateral, making it vulnerable during medial approaches or medial wall blowout fractures, but not typically the extensile lateral approach.B. Deep peroneal nerve:This nerve is located in the anterior compartment of the leg and innervates the dorsum of the foot. It is not typically at high risk during a lateral calcaneal approach.D. Superficial peroneal nerve:This nerve is also in the lateral compartment of the leg and innervates the lateral aspect of the lower leg and dorsum of the foot. While it can be at risk in more anterior lateral approaches to the ankle, the sural nerve is the primary concern for the extensile lateral approach to the calcaneus.E. Medial plantar nerve:This nerve is a terminal branch of the posterior tibial nerve, located on the plantar aspect of the foot, and is not at direct risk during a lateral calcaneal approach.

Question 1215

Topic: 8. Foot and Ankle

During the reduction sequence of a displaced intra-articular calcaneal fracture via an extensile lateral approach, the surgeon aims to restore the posterior facet congruity. Which of the following calcaneal fragments serves as the most crucial and reliable reference point for achieving anatomical reduction of the posterior facet?

. A. Lateral wall fragment
. B. Tuberosity fragment
. C. Anterior process fragment
. D. Sustentaculum tali fragment
. E. Thalamic fragment

Correct Answer & Explanation

. D. Sustentaculum tali fragment

Explanation

Correct Answer: DExplanation:The case explicitly states under 'Biomechanics of Fracture' and reiterated under 'Reduction Sequence' that the 'Sustentacular Fragment: Often remains attached to the talus via the strong interosseous ligament and usually maintains its position relative to the talus. This makes it a crucial reference point for anatomical reduction.' It further emphasizes under 'Posterior Facet Disimpaction and Reduction' that 'The sustentaculum tali fragment, which usually remains anatomically aligned with the talus, serves as the primary reference point for restoring the posterior facet.'A. Lateral wall fragment:This fragment is often comminuted and displaced laterally, and its reduction is secondary to the posterior facet. It acts as a buttress after posterior facet reduction.B. Tuberosity fragment:While important for restoring calcaneal length and Achilles tendon attachment, it is often rotated and displaced and is not the primary reference for posterior facet congruity.C. Anterior process fragment:This fragment is anterior to the subtalar joint and not directly involved in the reduction of the posterior facet.E. Thalamic fragment:This is the main weight-bearing portion of the posterior facet, which is often depressed and comminuted. It is the fragment that needs to be reduced, not a reference point for its own reduction.

Question 1216

Topic: Midfoot & Hindfoot
A 40-year-old construction worker undergoes ORIF for a Sanders Type III calcaneal fracture. Post-operatively, he develops persistent pain, stiffness, and limited subtalar motion, despite appropriate rehabilitation. Radiographs show some residual articular incongruity. Based on the case, what is the most common long-term complication following calcaneal fracture fixation, even with anatomical reduction, that this patient is likely experiencing?
. A. Nonunion
. B. Peroneal tendon impingement
. C. Post-traumatic subtalar arthritis
. D. Tarsal tunnel syndrome
. E. Complex Regional Pain Syndrome (CRPS)

Correct Answer & Explanation

. C. Post-traumatic subtalar arthritis

Explanation

Post-traumatic subtalar arthritis is the most common long-term sequela following calcaneal fracture, even with anatomical reduction, with an incidence of 30-70%. The patient's symptoms of persistent pain, stiffness, and limited subtalar motion, along with residual articular incongruity, are classic signs of developing subtalar arthritis.

Question 1217

Topic: 8. Foot and Ankle
A 42-year-old male undergoes ORIF of a displaced intra-articular calcaneal fracture. During the procedure, the surgeon utilizes intraoperative fluoroscopy to confirm anatomical reduction and stable fixation. Which specific fluoroscopic views are most crucial for assessing posterior facet congruity and restoration of calcaneal angles?
. A. Anteroposterior (AP) and oblique views of the foot.
. B. Lateral and axial (Harris) views of the calcaneus.
. C. Mortise and AP ankle views.
. D. Broden's views and lateral calcaneal view.
. E. Calcaneocuboid and talonavicular joint views.

Correct Answer & Explanation

. D. Broden's views and lateral calcaneal view.

Explanation

Broden's views (oblique views of the subtalar joint) are used to evaluate posterior facet congruity. The lateral view allows assessment of Böhler's and Gissane's angles. Frequent fluoroscopic imaging (lateral, axial, Broden's views) is used to confirm articular reduction and restore these angles.

Question 1218

Topic: 8. Foot and Ankle

During surgical fixation of a displaced intra-articular calcaneal fracture via an extensile lateral approach, which of the following fragments remains attached to the talus and serves as the "constant" reference point for reduction?

. Tuberosity fragment
. Anterior process fragment
. Lateral joint fragment
. Sustentaculum tali fragment
. Posterior tuberosity fragment

Correct Answer & Explanation

. Sustentaculum tali fragment

Explanation

The sustentaculum tali fragment, located anteromedially, is considered the constant fragment because it remains tightly bound to the talus via the strong talocalcaneal ligaments. It serves as the primary keystone for anatomic reduction.

Question 1219

Topic: 8. Foot and Ankle
A patient presents with a severe heel injury after a fall. Normal lateral radiographs of the calcaneus typically exhibit a Böhler's angle in which of the following ranges?
. A. 0 to 10 degrees
. B. 10 to 20 degrees
. C. 20 to 40 degrees
. D. 40 to 60 degrees
. E. 60 to 80 degrees

Correct Answer & Explanation

. C. 20 to 40 degrees

Explanation

The normal Böhler's angle, formed by lines drawn tangentially to the anterior and posterior aspects of the superior calcaneal surface, typically ranges from 20 to 40 degrees. A decreased angle indicates a depression of the posterior facet.

Question 1220

Topic: 8. Foot and Ankle

A 55-year-old male complains of severe lateral hindfoot pain and a feeling of instability when walking on uneven ground, two years after nonoperative management of a displaced intra-articular calcaneus fracture. Physical exam reveals focal tenderness just distal to the lateral malleolus. What is the most likely cause of his symptoms?

. Subtalar osteoarthritis and lateral impingement
. Nonunion of the calcaneal tuberosity
. Sural neuroma
. Avascular necrosis of the talus
. Tibialis posterior tendon dysfunction

Correct Answer & Explanation

. Subtalar osteoarthritis and lateral impingement

Explanation

Following conservative management of displaced intra-articular calcaneal fractures, patients frequently develop post-traumatic subtalar arthritis. Lateral wall blowout can also cause impingement of the peroneal tendons and fibula, exacerbating lateral hindfoot pain.

Test Yourself

Switch to an interactive, timed exam simulation to truly master this topic.

On this Page